Report: Knox County drug-related deaths up by 31 percent, with fentanyl taking major toll

More than 300 people gathered at the Women's Basketball Hall of Fame to memorialize lives lost to drugs and talk about how to stem the tide of new deaths.
Kristi L. Nelson - USA TODAY NETWORK - Tennessee

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At center Dr. Darinka Mileusnic-Polchan, chief medical examiner for Knox County stands in the doorway of the evidence room while speaking about the area's drug abuse epidemic, as manager of the medico-legal death investigation department Robin Slattery listens, in the Knox County Regional Forensics Center on Thursday July 13, 2017.(Photo11: CAITIE MCMEKIN/NEWS SENTINEL)Buy Photo

More Knox Countians than ever before are dying from drugs – and fentanyl is the top killer.

In 2016, Knox County saw a 31 percent increase in deaths caused by drugs – higher than the state or U.S. More than a tenth of them involved fentanyl and drugs containing fentanyl – in some cases, drugs so powerful they can’t be reversed by naloxone, a medicine given in emergencies to revive those who overdose on opioids.

The number of drug-related deaths jumped from 170 in 2015 to 224 in 2016, according to a report released today by the Knox County Regional Forensic Center. The increase outpaced the rise in Knox County deaths handled by the forensic center, and drug-related deaths made up more than 18 percent of all autopsies and exams conducted by the center.

Since 2010, the number of drug-related deaths handled by the forensic center has increased by 157 percent. Anderson County, whose cases the center also handles, has seen a similar rise.

And Chief Medical Examiner Dr. Darinka Mileusnic-Polchan doesn’t see any relief on the horizon: Already, preliminary numbers for the first half of 2017 project an increase of about 25 percent in the number of drug-related deaths, the report said.

Increased risk to ages 25-34

Right now, ages 45-54 account for more drug-related deaths in Knox County – 28 percent. But Mileusnic-Polchan expects the 25-to-34 age group, which now accounts for nearly 20 percent of drug-related deaths, to overtake other age groups very soon. From 2015-2016, drug-related deaths in the 25-to-34 age group increased by 144 percent – and they died from a higher percentage of illicit drugs, versus prescription drugs, than any other age group. Fentanyl-related deaths for that group jumped 500 percent between 2015 to 2016.

“These are healthy, younger people – they don’t have a lot of chronic illnesses contributing” to their deaths, Mileusnic-Polchan said. The report counts all drug-related deaths the center handles, even those attributed to medications for which a person might have a valid prescription.

But prescription painkillers are harder to get than they have been in past years, in part because of a crackdown on clinics that were overprescribing them, Mileusnic-Polchan said. She thinks that’s one of many contributing factors that have synthetic drug overdoses “exploding” – illicit and emerging “designer” drugs may account for as many as half of 2017’s drug-related deaths, she said.

They also place a burden on the forensic center, which has to send samples to a specialized lab to test for emerging drugs, at a cost of $200-$500 per test.

'Designer drugs' on rise

Without additional funding, the center must weigh whether to spend the money to test for a new drug if the death can already be ruled drug-related because other, known drugs are present as well. (More than one drug is found in 66 percent of Knox County’s drug-related deaths.)

On the other hand, “unless you know what you’re testing for, you don’t know what you’re fighting and how to combat the rise of these drugs,” Mileusnic-Polchan said.

Such was the case in May 2015, when investigators at the death scene of a known drug dealer found among his neatly packaged baggies of drugs some labeled “U47700.”

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Pharmaceutical medicines confiscated from cases sit in a locked drop box in the evidence room after being accounted for in the Knox County Regional Forensics Center on July 13, 2017. The pills are turned over to the Knoxville Police Department to be destroyed.(Photo11: Caitie McMekin / News Sentinel)

“We had never seen that before,” and neither had the national lab they retained for testing, said Regional Forensic Center Senior Director John Lott. Six months later, the lab called back and said that with a new test, they’d identified the synthetic opioid, also known as "Pink" and "Pinky," in one of the samples they’d kept.

“It’s not really what we want to be known for, but we were the first people in the nation to identify U47700 in a drug death,” Lott said.

These days, the forensic center gets drug-death information to law enforcement and the district attorney’s office every day. All serve on the Knox County Drug Enforcement Task Force, formed in 2016 to make sure drug-related death data is immediately logged and shared among agencies.

That ensures all are aware of the trending of more potent illicit drugs. Pharmaceutical-grade fentanyl, for example, is 50 to 100 times more potent than morphine – but some of its analogues can be as much as 10,000 times stronger. People buy the drug from online lab supply companies or obtain it from other countries, then use it to make new drugs or counterfeit versions of popular drugs like Oxycodone and Xanax.

Then, people who buy drugs off the street “don’t understand what they’re getting, the quality, the potency,” Lott said. “And also, with naloxone being present, I think people feel like, ‘Hey, I’m going to be able to get it reversed.' ”

Naloxone not always working

A long-time staple for ambulances, the drug has become widely used by fire departments, police departments and even “good Samaritans” over the past year. Yet, with new potent synthetic drugs, “the usual dose of naloxone isn’t enough,” Mileusnic-Polchan said.

In 2016, the forensic center found naloxone present in the systems of 44 people whose deaths were ruled drug related – nearly 20 percent of all drug-related deaths.

In addition, it was present in even more cases where drug overdose wasn’t ruled the direct cause of death: car accidents, suicides and homicides, for example.

After fentanyl and its analogues, the drugs most commonly found in drug-related deaths were oxymorphone, oxycodone, alprazolam, methamphetamine, cocaine, hydrocodone, morphine, alcohol and heroin. Buprenorphine (suboxone) and methadone were Nos. 11 and 12 on the list. Methamphetamine, long a scourge of rural areas, hadn’t been in Knox County’s Top 10 list since 2013, and Mileusnic-Polchan said the varieties showing up now are likely imported rather than homemade, because they’re more “pure” and “potent.”

Spanning races, ZIP codes

Men still outnumber women in drug-related deaths, the report found, and the problem isn’t confined to any one particular area of the county. In 2010, the 10 ZIP codes in Knox and Anderson counties with the most drug-related deaths were 37920, 37917, 37921, 37918, 37919, 37849, 37912, 37830, 37716 and 37915. Five – 37920, 37917, 37918, 37849 and 37912 – have appeared on that list every year since 2010.

Whites still make up the bulk of drug-related death cases – nearly 88 percent in 2016, the report found. But the number of drug-related death cases among blacks more than doubled between 2015 and 2016, from 10 to 23. (There were also four cases among Asians in 2016, compared to one in 2015, none in 2014 and four in 2013.)

The report said there were already 23 drug-related deaths among blacks in the first half of 2017, so “we expect the number of drug-related deaths in blacks to double” again.

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Medico-legal death investigator Morgan Seymour uses a pill counter to count pills confiscated from cases in the evidence room in the Knox County Regional Forensics Center on Thursday July 13, 2017. The pills are turned over to Knoxville Police Department to be destroyed.(Photo11: CAITIE MCMEKIN/NEWS SENTINEL)

To fight epidemic, changes needed

The report urges some changes, including more funding for toxicology testing as drug-related deaths continue to rise, and funding for agencies doing education, prevention and drug reduction activities.

It also recommends the creation of a statewide electronic Death Certificate system to track deaths in real time and standardize the way cause of death is reported, since that varies from county to county. The statewide number of drug-related deaths is nebulous now because not all cases are reported to medical examiners, and physicians may not provide all the necessary data when completing death certificates.

Finally, it notes there aren’t enough available treatment resources for those trying to beat addiction – especially for those who lack insurance and money.

Metro Drug Coalition and Cornerstone of Recovery will sponsor a Recovery Resource Fair from 9 a.m.-5 p.m. Sept. 21 at Central United Methodist Church, 201 3rd Ave. More than 40 booths will have information on employment, housing, financial aid, insurance, legal aid, transportation, treatment, community resources and social services.

And Recovery Strategies, a West Knoxville outpatient addiction treatment center, during September has vowed to provide a month of free treatment to people who haven't previously gotten addiction treatment and aren't getting treatment elsewhere. September is National Recovery Month. Call 865-966-3869 for information; the line is answered 24 hours.